‘Women don’t treat breastfeeding or breasts as a sexual thing. It’s mainly males’

Prof Afif El Khuffash wants to change Ireland’s views about breastfeeding — and he’s doing it through art as well as his work as a neonatologist

Afif El Khuffash is one of only a handful of male lactation consultants in Ireland. He worried that his gender might be an issue, which he says “feeds into the whole topic of the sexualisation of breastfeeding”. “I initially thought, should I be doing this? How am I going to be perceived? But I’ve had nothing but a great response from everybody, which shows that women don’t treat breastfeeding or breasts as a sexual thing. I think it’s mainly males.”

Ireland’s breastfeeding rates “are shockingly low”, says El Khuffash, who is a consultant neonatologist at the Rotunda maternity hospital in Dublin and a clinical professor of paediatrics at the Royal College of Surgeons in Ireland. “I think about 75 per cent of mothers during pregnancy intend to breastfeed, and out of that 75 per cent only one-third leave the hospital exclusively breastfeeding — so two-thirds of mothers that are intending to breastfeed end up using formula over the first few days after the baby is born, for whatever reason. After that the rates of breastfeeding at six months of age are only 10-15 per cent. That’s one of the worst figures in the world, unfortunately.

“The reason for the low breastfeeding rates is obviously multifactorial: we lack support in the community, we don’t have enough midwives to give enough support and time to mothers following the delivery of their babies, and also, I think, the public perception of breastfeeding.”

“There’s still a lot of barriers to breastfeeding in public”, El Kuffash says. “That was becoming increasingly clear after I became a lactation consultant and got more closely involved in supporting mothers — the public perception needs to improve. The imagery of breasts and the sexualisation of breasts needs to be challenged, because a lot of mothers, I think, still feel uncomfortable breastfeeding in public.”


There is still a belief that breastfeeding should be hidden and done only in private, El Khuffash says. “There are comments like, ‘Women only breastfeed to lure men,’ or, ‘I don’t want to be looking at that while I’m getting my hair done.’”

It is the sexualisation of breastfeeding that has inspired El Khuffash to make the paintings in his upcoming art exhibition. “What prompted me to do this art exhibit is to challenge this stigma and challenge that view, and the paintings that I’ve done, they vary in composition and what’s in them, but a lot of them are mothers breastfeeding, and their breasts are exposed. I just want people to be able to see it and look into themselves and take a step back and think, How does this make me feel, looking at this, and really challenge the taboo of breastfeeding.”

Irish attitudes to breastfeeding are very different from attitudes in Sweden, which El Khuffash recently visited for a medical conference. “The breastfeeding rates in Sweden are really, really high, and public perception of breastfeeding is very, very positive. In fact, people almost go the other way, of encouraging mothers that are seen to breastfeed in public, and they receive really good comments.”

El Khuffash thinks things are changing in Ireland — slowly. “I hate to say this and bring gender into it, but I think men need to change their perception and their views of breast imagery, of mothers breastfeeding in public, that there’s nothing sexual about that. Because I think that kind of discomfort transcends, and mothers feel it, and then they end up not wanting to do it in public, and that can only have a negative impact on breastfeeding.

“Breasts have been sexualised so much in society that it’s becoming almost shameful to speak about breasts... But if more men began to challenge that, then I think things will improve, because I don’t think it’s coming from women.

“We really need to work on men, and have a conversation with men, and it’ll be great if more men began to speak out about this, because I think it will improve the overall perception of breastfeeding in public. I think a lot of men feel ashamed and feel embarrassed, and that’s what needs to be challenged as well.”

The sexualisation of breasts was evident when El Khuffash tried to promote his upcoming exhibition on social media. Instagram blocked his promotion twice, he says. “I think that, again, is a reflection of how pervasive sexualisation of breasts is... You’re not allowed to show nipples on Instagram.” He was finally allowed to promote his exhibition on his third attempt, having appealed the social-media platform’s decision twice.

The exhibition aims to “show there is no shame in breastfeeding, there is no shame in talking about it in public and there is no shame in promoting it”. It “is not to make mothers feel bad about whatever choice they make. If mothers choose to use different methods of feeding, using formula or bottle, that is completely fine and completely acceptable, but the whole point of this is that they should be free to make their choice without external pressures.”

As World Breastfeeding Week approaches — it runs from August 1st to 7th — El Khuffash is conscious of sensitivities around breastfeeding. “I often see there is some resentment that comes during World Breastfeeding Week from mums that chose not to breastfeed, and they feel left out. I think what we need to do is celebrate all mother-and-baby relationships.”

The health benefits of breastfeeding are clear, for baby and mother. “We know that babies that are breastfed have less lung infections, less ear infections and less gastrointestinal infections over the first few months of life. We know that they have less allergies down the line and they’re at less risk of obesity down the line as well. In terms of mothers there’s also lots of benefits in terms of breast cancer and ovarian cancer as well, and mums that choose to breastfeed can return to their prepregnancy weight a lot sooner than mums that use formula. There are a lot of health benefits for both mother and baby.”

El Khuffash points also to research which has shown that when breastmilk is given to premature babies, whose prematurity puts them at increased risk of cardiac problems and high blood pressure, those risks decrease. “Something as simple as giving preterm babies breastmilk, instead of formula, can actually cause a huge reduction in cardiovascular risk later on in life.”

“Beyond that is the advantage of being able to feed your baby anywhere without lugging bottles and powder and formula everywhere with you. I don’t like the term that breastfeeding is natural, because it sort of implies that mothers and babies should pick up on it without support and they should be able to do it. I think that term is loaded, and it puts a lot of pressure on mothers.”

Investing in supporting women to breastfeed promises a longer-term benefit, not only because breastfeeding is sustainable but also because of the potential to ease future pressures on a struggling health system. “It’s a relatively small investment early on for a long-lasting benefit in terms of reducing the burden on the health service further down the line. If we reduce the risk of obesity, if we reduce the risk of heart disease, they are two huge contributors to healthcare spending in Ireland...

“Formula companies are not allowed to advertise the first formula that babies get, so they heavily invest in advertising follow-on formulas, which have no benefits at all. In fact, you could use the number-one formula for the first year of the baby’s life and then switch to cow’s milk after that. There’s no actual need for formula number two, and certainly there’s no need for that follow-on or toddler formula that babies sometimes get after a year of age.”

El Khuffash has received positive reactions from women about his upcoming exhibition, which opens tomorrow and runs through World Breastfeeding Week. He hasn’t received many comments from men and wonders if this is because “men feel this is not their place... Is their concern that if they start talking about this they’d be misunderstood? I’d love as many men as possible to come to the art exhibit.

“I suppose me as a man promoting this, I think, is a good thing, because I want people to see that it’s okay for a male to promote this, to challenge the breastfeeding stigma and, I suppose, to promote positive imagery of breastfeeding.”

Afif El Khuffash’s exhibition Fighting the Breastfeeding Stigma through Art opens on July 28th and runs until August 4th at the Copper House Gallery, Dublin

Jen Hogan

Jen Hogan

Jen Hogan, a contributor to The Irish Times, writes about health and family